MEDI-CAL PROGRAM LOS ANGELES COUNTY DEPARTMENT OF PUBLIC SOCIAL SERVICES - DPSS
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1 MEDI-CAL PROGRAM LOS ANGELES COUNTY DEPARTMENT OF PUBLIC SOCIAL SERVICES - DPSS W O R K F O R C E D E V E L O P M E N T B O A R D A J C C P A R T N E R S
2 MEDI-CAL PRESENTATION Medi-Cal Overview Health Care Reform Eligibility Requirements MAGI Medi-Cal Non-MAGI Medi-Cal Minimum Essential Coverage Application Process How to Apply
3 MEDI-CAL OVERVIEW The Medi-Cal Program provides comprehensive medical coverage to eligible individuals. Medi-Cal eligibility can be established under two categories Modified Adjusted Gross Income (MAGI) Medi-Cal Non-MAGI Medi-Cal
4 HEALTH CARE REFORM OVERVIEW Health Care Reform (HCR) is also known as the Affordable Care Act (ACA). All U.S. Citizens and Legal Permanent Residents are required to have health insurance coverage, or face tax penalties (Individual Mandate). Requires insurance plans to provide Minimum Essential Coverage (MEC) benefits. HCR established the Health Insurance Exchange known as Covered California.
5 MEDI-CAL ELIGIBILITY REQUIREMENTS California residency Identification Citizenship/Immigration status Income Medical Support Enforcement (MSE) Property/resources are ONLY required for Non-MAGI Medi-Cal.
6 MODIFIED ADJUSTED GROSS INCOME (MAGI) MEDI-CAL MAGI Medi-Cal is the new Medi-Cal program created under HCR that covers: Adults (19-64)- Income up to 138% FPL Children (under age 19)- Income up to 266% FPL Parents/Caretaker relatives Income up to 109%FPL Pregnant Women- Income up to 213%FPL
7 MAGI MEDI-CAL Modified Adjusted Gross income (MAGI) is a methodology based on IRS tax rules. MAGI methodology determines household composition and how income is treated for the new HCR programs. Assets and property are waived under MAGI methodology.
8 NON-MAGI MEDI-CAL Non-MAGI Medi-Cal is the new term for the Medi-Cal programs that existed before HCR and still remain with the same rules: Supplemental Security Income (SSI) Foster Care/Former Foster Youth Medi-Cal Program Seniors (65 or over) and Persons with Disabilities Long Term Care (LTC) Home and Community Based Waiver Medicare Savings Programs (MSP) 250% Working Disabled Program Pickle Program Dialysis and Related Services Medically Needy (MN) and MN Sneede Minor Consent
9 MINIMUM ESSENTIAL COVERAGE (MEC) Under HCR, insurance plans must provide Minimum Essential Coverage (MEC), which includes: Ambulatory Services Emergency Services Hospitalization Maternity and newborn care Mental health and substance abuse disorder services, including behavioral health treatment Prescription drugs Rehabilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including dental and vision Note: As of May 2014, Medi-Cal Covers dental care for adults.
10 HOW TO APPLY To apply on-line via the Your Benefits Now webpage: To have an application mailed directly to you, or to find the nearest office to you, call of one Customer Service Center: Toll Free Number (866) Covered California:
11 MEDI-CAL APPLICATION SINGLE STREAMLINED APPLICATION (SSApp) The SSApp is used to apply for the following health insurance affordability programs: Medi-Cal (MAGI & Non-MAGI) Subsidized Coverage (APTC/CSR) SSApp captures tax filer and tax dependent information, including income and immigration status.
12 COVERED CALIFORNIA Covered California Is a statewide marketplace where individuals can shop on-line or over the telephone for insurance coverage. Covered California provides subsidized assistance to individuals with income over MAGI Medi-Cal limits but under 400% FPL via: Advanced Premium Tax Credits (APTC) Cost Sharing Reduction (CSR) Subsidies
13 WHEN TO APPLY There is no open enrollment to apply for Medi-Cal. Medi-Cal applications are accepted all year-round.
14 QUESTIONS
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